More and Better Drugs
It's a troubling paradox. As medication breakthroughs offer new
hope for controlling health disorders, medication errors are harming
more and more Americans. The treatment of virtually every major
illness has been revolutionized in recent years by the advent of
more effective and powerful agents. Take diabetes. Not so long ago
the only pharmacological treatment options were insulin and a handful
of fairly primitive oral agents. Today, in 2003, physicians can
choose from five different classes of pills and ten insulin formulations.
Coupled with this new armamentarium has been the clear demonstration
that aggressive treatment greatly reduces diabetic complications.
Thus diabetes today is often treated with combinations of drugs
with complementary mechanisms of action.
The same is true of many chronic disorders common
in our society, especially among older adults. Hypertension (high
blood pressure), coronary artery disease, arthritis, cancer, hyperlipidemia,
depression and many other disorders are now routinely treated more
vigorously and with more drugs than ever before. In the United States,
3.3 billion retail prescriptions were written in 2001 as compared
with 2.7 billion in 2000. By 2004 the number is expected to exceed
4 billion. Seniors, who represent 13% of the population, account
for 34% of these prescriptions. According to Georgetown University's
Center on an Aging Society, individuals between 65 and 79 years
of age receive an average of 20 prescriptions each year. For people
over 79, the number is 22 each year. These figures don't even take
into account the billions of over-the-counter drugs Americans purchase
every year.
Drug Errors are the Norm, not the Exception
Errors in taking, prescribing and complying with drug regimens have
a long and sad history in our health system. But with the growing
number of drugs and complexity of medication regimens, this longstanding
problem is only getting worse. One reflection of the problem is
the high frequency of discrepancies between what patients are actually
taking and what their doctors' records indicate. A 2000 report published
in the Archives of Internal Medicine revealed such discrepancies
in fully 76% of the patients studied. Of those cases, 51% were taking
a medication that was not recorded, 29% were not taking a recorded
medication and 20% had dosing discrepancies.
Why are so many people taking drug regimens that
differ from their doctors' records? One reason is the soaring cost
of drugs, which causes many patients to cut back on pills or leave
prescriptions unfilled. But the central factor is poor communication
between patients and health professionals. At the time a medication
is prescribed, patients are often poorly informed about the risks,
benefits and importance of compliance, leaving many skeptical or
uncertain. When side effects occur, some patients stop or adjust
the dose on their own, rather than seeking a collaborative solution
with their physician.
Another aspect of the problem is the woefully
inadequate record-keeping and communication among providers within
our fragmented health system. In a given year, a typical elderly
patient has numerous telephone and in-person interactions with several
health providers. Medication regimens may be changed at virtually
every physician visit. How likely is it that everyone involved in
a given patient's care will be fully up to date on that patient's
medication regimen? It is no wonder that miscommunication occurs
so often.
Medication Errors Cause Serious Harm
Inappropriate use of medications can cause harm as the result of
dangerous side effects, drug interactions or inadequate treatment.
Medication errors can be thought of as falling into three categories:
overuse, underuse and misuse. Taking medications unnecessarily or
in excessive doses (overuse) can of course lead to preventable side
effects. But underuse is just as serious, because many patients
unfortunately fail to receive the benefits that state-of-the art
treatment can offer. Misuse refers to inappropriate prescribing
by physicians or self-administration by patients, both unfortunately
very common.
Medication errors take a staggering toll in terms
of complications, preventable hospitalizations, inadequate treatment
and even death. In fact, just the preventable deaths (the tip of
the iceberg) exceed 7,000 per year, according to a respected 1999
study of medical errors by the Institute of Medicine.
What Can Patients Do?
It is certainly be true that the health care industry has a lot
to answer for in the area of medication error. But fortunately,
patients and families have it in their power to improve this problem
enormously. Here are some tips:
• Be an active participant in all medication
treatment decisions. Make sure you understand the reasons a given
drug is being prescribed, exactly how to take it safely, and what
side effects are possible.
• Keep careful track of any drug allergies or previous adverse
effects from drugs.
• Bring all medication bottles, prescription and non-prescription,
to every visit with a health professional-even if you are not asked.
Have someone go over your medications and check for any discrepancies
with the medical record.
• Be honest. If you didn't follow instructions for whatever
reason, say so. Don't leave your physician with the impression that
you're taking a medication if you're not.
• Don't "self-prescribe" over-the-counter drugs
for chronic conditions. The drugs approved for over-the-counter
use in recent years are more powerful than ever. Besides causing
potential serious side effects independently, they may interact
adversely with prescriptions you are taking.
• Use a pill dispenser if you have problems remembering to
take your medications at the right time. There are many excellent
designs available.
• Ask your physician if a consultation with a pharmacist is
covered by your health plan. Pharmacists have been playing a larger
role in the health care team in recent years.
• If a doctor advises you to change a medication that another
doctor prescribed, satisfy yourself that they have communicated
with one another about the change.
• Keep an up-to-date, accurate and detailed list of all your
medications readily available at all times. Include any medication
allergies or intolerances. In an emergency, this can be life-saving.
Where to get additional information:
The following organizations are good sources of information about
preventing medication errors.
The National Council on Patient Information and Education (NCPIE)
(301) 656-8565 www.talkaboutrx.org
The Institute for Safe Medication Practices (215) 947-7797 www.ismp.org
The American Pharmaceutical Association (Look for the brochure,
Before You Take Your Medicine, Take This Advice) www.aphanet.org
January, 2003 |
